excretion & reproduction module (2011/12 batch) - year 1

1

Excretion & Reproduction Module – (2011/12 Batch) - Year 1 Semester II Web Copy

Final document - 30th September, 2013

Concept Objectives Time Dept in-

charge T/L activity

The student should be able to,

2011-1/SBM-5/01

Introduction to

Excretion

1. explain what is meant by excretion

2. explain why the body requires excretory mechanisms to maintain

health

3. list the organ systems involved in excretion

4. list the waste products excreted by each of the above system

5. explain the role of the following in excretion

(i). skin

(ii). liver, biliary complex and the gut

(iii). lungs

(iv). kidneys and the urinary tract

6. examination of normal urine – Urinalysis

(i). volume/ appearance/ osmolality/ pH

(ii). presence of blood, glucose, protein

(iii). cells, casts, bacteria

1h

2h

Head/

Biochemistry

Head/

Biochemistry

Lecture

PD

2011-1/SBM-5/02

Posterior

abdominal wall

1. describe the posterior abdominal viscera

2. describe the arrangement of muscles and fascia in the posterior

abdominal wall

3. describe the structures found on the posterior abdominal wall

1h

6h

Head/ Anatomy

Dissections

Lecture

Dissections

Chairperson Curriculum Coordinating Committee, Faculty of Medicine, Peradeniya.

2

2011-1/SBM-5/03

Kidneys and the

urinary tract

a. Gross and

microscopic

anatomy of

kidneys and the

urinary tract

b. Osteology of the

pelvis

1. list the components of the urinary system

2. describe the gross structure of the kidneys, Ureters and bladder

3. describe how the urinary system is adapted to perform its function

4. describe the unique blood circulation of the kidney

5. describe the venous drainage and nerve supply of the kidney

6. state the lymphatic drainage

7. describe the histological appearance of the urinary system

1. identify the bones and ligaments forming the pelvis.

2. name and identify the major foramina of the bony pelvis.

3. differentiate between the true pelvis and the false pelvis in terms of

their structures and locations.

4. identify all bones found in this region and discuss the role of any

associated tuberosities, grooves and prominences

5. describe the differences observed between the male and the female

pelvis

Applied anatomy of the urinary system

3h

2h

3x2h

3 h

1h

Head/ Anatomy

Dissections

Lecture

Histology

practical

Dissections

Lecture

2011-1/SBM-5/04

Normal imaging

Anatomy of the

urinary tract

1. list the different imaging modalities used to assess the urinary system

2. identify the normal imaging anatomy of the urinary system in

different imaging modalities

1h

Radiology

Lecture

2011-1/SBM-5/05

Development of

the kidneys and

the Urinary tract

1. describe the development of the urinary system

(i). pronephros

(ii). mesonephros

(iii). metanephros (Permanent Kidney)

(iv). bladder and urethra

2h

Head/ Anatomy

Lecture

2. describe the anatomical basis of the following

(i). congenital malformations

(ii). congenital polycystic kidney

(iii). pelvic kidney

(iv). horse-shoe kidney

(v). renal agenesis

(vi). double ureter

(vii). urachal fistula, cysts and sinuses

1h

Head/ Anatomy

Lecture


3

2011-1/SBM-5/06

summarize the structural adaptations of the urinary system for effective

function

2hrs Head/ Anatomy Student seminar

with task

2011-1/SBM-5/07

Functions of the

kidneys

Formation of

urine

1. recognise that the functional unit of the kidney is the nephron.

2. list the two different types of nephrons and state the structural differences

between them

3. describe the process of urine formation - filtration, secretion and

reabsorption

1h Head/

Physiology

Lecture

2011-1/SBM-5/08

GFR and factors

affecting GFR

1. describe the glomerular membrane, in terms of the major layers and its

permeability characteristics.

2. explain in terms of size and electrical charges of the pores of the

membrane and why the glomerular membrane has a high degree of

selectivity.

3. state the glomerular pressure, Bowman's capsular pressure and the colloid

osmotic pressure in the glomerular capillaries and explain how these

pressures cause filtration of fluid at the glomerulus.

4. state the composition of the glomerular filtrate.

5. explain the terms GFR and filtration fraction and give their normal values.

6. describe the effect of the following on the GFR:

(i). renal blood flow

(ii). afferent arteriolar constriction

(iii). efferent arteriolar constriction

(iv). sympathetic stimulation

(v). outflow obstruction

7. recognise that GFR is kept constant with wide changes in arterial blood

pressure by means of "autoregulation".

2h

2h

Head/

Physiology

Head/

Physiology

Lecture

SGD

2011-1/SBM-5/09

a. Tubular

functions

1. compare the structural characteristics and the absorptive properties of the

epithelial cells in the proximal tubule, thin and thick segments of the loop of

Henle, the diluting segment, the late distal tubule and the collecting duct.

2. recall the processes of primary and secondary active transport.

3. recognise that nutrients such as glucose, proteins, amino acids and

vitamins are almost completely reabsorbed by active transport.

4. explain the process of glucose transport

5. explain the concept of tubular maximum as applied to glucose transport.

6. describe by giving examples the process of passive absorption Recognise

that water transport occurs entirely by osmotic diffusion and state the

volumes of fluid flowing per minute and percentages reabsorbed at

different parts of the tubule.

3h

Head/

Physiology

Lecture


4

b. Renal clearance,

counter current

mechanisms – 2h

Lectures (+ 2h

SGD)

c. Renal handling

of water

7. recognise that major metabolic end-products such as urea and creatinine

are poorly reabsorbed.

8. describe the process of reabsorption of electrolytes Na+ , K

+ , Cl

- and

HCO3- by the tubules.

Clearence

1. explain the concept of plasma clearance and indicate how clearance of a

substance is affected by reabsorption and secretion.

2. explain how GFR can be measured by using inulin, creatinine and urea.

state the advantages and disadvantages of the above substances as

measures of GFR.

3. explain how PAH (para-aminohippuric acid) is used to measure renal

plasma flow

1. explain the role of ADH in producing a dilute urine.

2. explain how the loop of Henle functions as a countercurrent multiplier

and the vasa recta function as countercurrent exchangers.

3. explain the role of ADH and the countercurrent mechanism in

concentrating urine.

4. explain the hypothalamic mechanism controlling ADH secretion and

thirst.

5. state the normal range of volume, specific gravity and osmolality of

urine.

6. explain the terms: water diuresis, osmotic diuresis, pressure diuresis.

7. To assess the excretion of water and solutes under resting conditions

and after ingestion of different fluid/solute loads.

8. measure volume and specific gravity of urine.

1h

1h

2h

3h

Head/

Physiology

Head/

Physiology

Head/

Physiology

Head/

Physiology

Lecture

Lecture

SGD

PD

2011-1/SBM-5/10

Acid-Base balance 1. recognise that large amounts of HCO3- are filtered at the glomerulus and

H+ is secreted into the tubular lumen and that pH can be controlled by a

balance between these two processes.

2. explain the mechanism of transport of H+

and HCO3- in the proximal and

distal tubular segments.

3. describe how H+ are buffered in the kidney by the following;

(i). ammonia buffer

(ii). bicarbonate buffer

(iii). phosphate buffer

4. state the possible limits of pH in urine

1h Head/

Physiology

Lecture


5

11-1/SBM-5/11

Functions of the

kidneys

1. describe the Urea cycle/ xenobiotics

(a). Enzymes of the urea cycle

(b). Regulation of urea biosynthesis

(c). Urea cycle enzymopathies

(d). Effects of hyperammonemia

(e). Urea cycle enzymes in kidney

(f). Xenobiotice

2. describe the regulation of erythropoiesis by kidneys

3. describe the contribution to the synthesis of Vitamin D

4. describe the fluid and electrolyte balance in,

i. control blood volume by regulating the volume of urine produced

ii. regulates the homeostasis of major ions in the body fluids:

a. state the osmolality and Na+

concentration of ECF

b. recognise that ECF osmolality is determined mainly by Na+

concentration

c. describe the role of the hypothalamic osmoreceptors and ADH in

controlling ECF osmolality.

d. state the location of the thirst centre and describe the role of the thirst

mechanism in controlling ECF osmolality and Na+.

e. explain the renin-angiotensin-aldosterone mechanism.

f. explain the mechanism by which aldosterone controls Na+ transport in

the kidney.

g. recognise that Na+ is exchanged for K+ and/or H+ in the distal part of

the nephron.

h. explain the role of salt appetite in the control of ECF Na+.

I. explain the effect of arterial baroreceptors, low pressure receptors,

ANP, aldosterone and ADH in maintaining blood volume and ECF

volume.

j. explain the mechanism of K+ reabsorption and secretion in the renal

tubules.

k. explain the effect of aldosterone in the control of K+ secretion.

5. describe the regulate pH of the body fluids

*** Role of the kidney in regulation of BP

4h

3h

1h

4h + 1h

Biochemistry

Head/

Physiology

Head/

Anaesthesia

Lecture

Lecture

Lecture

CCR


6

2011-1/SBM-5/12

Micturition 1. describe the functional anatomy of the urinary bladder including the

innervations

2. describe the micturition reflex and explain how it is modified by

centers in the brain stem and cerebral cortex

3. explain the derangements in micturition in the following

abnormalities;

a. interruption of afferent nerves from the bladder

b. interruption of both afferent and efferent nerves

c. interruption of descending pathways

d. damage to spinal cord centres

1h

Head/

Physiology

Lecture

2011-1/SBM-5/13

Renal function in

different

physiological stages

functions of the kidney in:

1. Extremes of ages –

Childhood

Old age

2. Pregnancy

1h

1h

1h

Head/

Paediatrics

Head/ Medicine

Head/ Gyn &

Obs

Lecture

Lecture

Lecture

2011-1/SBM-5/14

a. Mechanisms of

dysfunction of

the kidneys and

the urinary

tract

b. Effects of

abnormal renal

function

c. Kidney and

Homeostasis

1. list the physiological consequences of reduced

nephron mass, GFR., tubular function etc

2. list 5 major causes that can lead to reduced GFR.

3. list the effects of reduced GFR on function of

other organ systems

4. list the effects on the kidney due to altered

functions of other systems

5. list conditions which causes obstruction to

the urine flow

6. define the term renal failure

i. identify abnormal constituents found in the urine

in renal diseases

ii. list important consequences of renal diseases

iii. Assessment of renal dysfunction and failure

Round up session using clinical case demonstration

2h

1h

2h

Head/ Medicine

Head/ Medicine

Head/ Medicine

Lecture

Lecture

Lecture


7

2011-1/CLM-5/01

Abnormal

constituents of urine

i. Abnormal constituents of urine

ii. Renal calculi

2h

(x 3)

Head/

Biochemistry PD

2011-1/SBM-5/15

Interaction between

the

urinary system and

other

systems

1. list other systems which interacts with the urinary system

2. summarize the interactions

4h

Implementation

by Physiology

CCR

2011-1/SBM-5/16

Introduction to

human

reproduction

1. recall the stages of meiosis

2. compare and contrast meiosis and mitosis

3. describe the advantages and disadvantages of sexual reproduction

1h

Head/ Anatomy

Lecture

2011-1/SBM-5/17

Biological

differences between

male and female

1. explain the structural, functional and behavioural differences between

a male and female 1h Head/ Psychiatry Lecture

2011-1/SBM-5/18

An overview of

reproduction

3. biochemistry of sex hormones

(i). state the sources, biosynthesis and metabolism of testosterone and

give the sources of other androgens in the body

(ii). describe the sources, biosynthesis and metabolism of the female

sex hormones

2h

Head/

Biochemistry

Lecture


8

2011-1/SBM-5/19

Structure of male

and female genital

tracts and the

breast

1. describe the gross structure of the male and female

genital systems

2. describe the light microscopic appearance of the

male and female genital systems

3. describe the gross structure and the light

microscopic appearance of the breast

4. applied anatomy of the breast

1h

2×3 h

1h

Head/ Anatomy

Head/ Anatomy

Anatomy to

arrange

Lecture

Histology

Practical

Lecture

2011-1/SBM-5/20

a. Normal imaging

anatomy of the

reproductive

system

1. list the different imaging modalities used to assess the male and

female reproductive systems

2. identify the normal imaging anatomy of the male and female

reproductive systems in different imaging modalities

1h

Radiology

Lecture

b. Imaging

Anatomy of the

common

developmental

anomalies of the

genito-urinary

system

1. Identify common developmental anomalies of the genito-urinary

system in different imaging modalities.

1h Radiology Lecture

2010-1/SBM-5/21

Spermatogenesis

and male sex

hormones

Spermatogenesis

1. recognise that spermatogenesis begins around

puberty and continues throughout life

2. describe the process of formation of spermatids and the formation of

male and female sperms.

3. state the role of Sertoli cells in spermatogenesis

4. state the role of the epididymis in sperm maturation and list the areas

where sperms are stored

5. describe the structure and functions of the mature sperm

6. state the life span of a sperm in the

(i). male genital tract

(ii). ejaculate

7. state the functions of the male accessory sexual structures

8. describe semen in terms of; contributory sources/ volume/ appearance/

pH/ composition

9. state the normal sperm count and give the effect of the sperm count on

fertility

2h

3h

Head/

Physiology

Head/

Physiology

Lecture

PD


9

Male sex hormones

10. state the pattern of testosterone secretion throughout the different

stages of life

11. explain the feedback regulation of testosterone secretion

12. explain the role of inhibin in spermatogenesis

13. state the effects of testosterone on

(i). development of primary and secondary sexual

characteristics in the adult

(ii). body hair distribution and baldness

(iii). voice /skin /muscular development

(iv). bone and Ca2+

metabolism

(v). erythropoiesis

2011-1/SBM-5/22

Ovarian cycle and

female sex

hormones

1. recognise that female sex hormones are secreted in a monthly cyclical

manner

2. describe the hormonal, functional and histological changes in the

human reproductive cycle in terms of the ovarian cycle/ the uterine

cycle and the cervix/ vaginal changes/ breast changes

3. describe the hormonal control of the reproductive cycle in terms of the

interaction between hypothalamic, pituitary and ovarian hormones

4. recognise that the reproductive cycles cease around menopause

5. state the effects of the estrogens on

(i). primary and secondary sexual organs

(ii). the breasts

(iii). the skeleton

(iv). the skin

(v). the pattern of fat deposition

6. describe the effects of progesterone on

(i). the uterus

(ii). the fallopian tube

(iii). the breast

(iv). Thermogenesis

3 h

2h

4h + 1h

Head/

Physiology

Head/

Physiology

CCR group

Lecture

SGD

CCR

2011-1/SBM-5/23

Adolescent

behaviour

1 define the term "adolescence"

2. explain the terms "gender, sex role identity" 1h Head/ Psychiatry

Lecture

2011-1/SBM-5/24

Puberty 1. explain the terms “thelarche”, “pubarche”, “menarche”, “adrenarche”

and “puberty”

2. explain the hormonal changes responsible for the onset of puberty

3. define the term “adolescence”

4. explain the terms “gender”, “sex role identity”

2h

Head/

Physiology

Lecture


10

2011-1/SBM-5/25

a. Psychosocial

aspects of human

sexuality

1. describe briefly the psychosocial aspects of human sexuality

2. explain the psychological concepts of masculinity and feminity

3. explain the term "sexual orientation"

1h Head/ Psychiatry Lecture

b. Sexuality and

sexual response

1. state the neuronal mechanism and the psychic stimuli involved in the

male and female during the sexual act

2. state the stages of the male sexual act including the role of the

autonomic nervous system

3. describe female orgasm and its associated physiological changes

4. explain the physiological changes associated with the sexual act

1h Head/

Physiology Lecture

2011-1/SBM-5/26

Fertilization and

tubal functions

1. recall the pathway taken by sperms (spermatozoa) from the site of

formation up to ejaculation

2. describe the role of neural reflexes in controlling penile erection and

ejaculation.

3. state the period of viability and the conditions affecting viability of a

sperm in the female genital tract.

4. describe the process and timing of fertilization, and where it takes

place.

5. describe the structural and functional changes of the endometrium in

relation to implantation and embryonic development

1h Head/

Physiology Lecture

2011-1/SBM-5/27

Contraceptives

describe the methods commonly used to prevent conception and their

sites of action

1h

Head/ Com.

Medicine

Head/

Physiology

Lecture

PD

2011-1/SBM-5/28

a. Pelvis,

reproductive

organs etc.

1. name and identify the blood vessels that pass from the posterior

abdominal wall into the pelvis.

2. identify the branches of the anterior and posterior divisions of the

internal iliac artery.

3. relate the muscles of the pelvic wall and floor to one another and to

their attachments.

4. differentiate between the pelvic diaphragm and the urogenital

diaphragm.

5. compare the organs in the female pelvis with those in the male pelvis.

6. describe the clinical significance of the peritoneal fossae related to the

uterus.

8h

Head/

Anatomy

Prosections

/Dissections


11

c. Perineum

7. describe the lymphatic drainage as it relates to the structures in this

region.

8. visualize and relate structures of the male and female pelvis with

respect to adjacent structures.

9. describe the differences between the male and

the female pelvis

10. applied anatomy of the pelvic organs

11. describe the general layout of the perineum

12. describe the urogenital diaphragm

13. describe the superficial and deep perineal pouch

14. describe the boundaries and regions of the perineum

15. identify the muscles of the male and female perineum and their

attachments.

16. differentiate between the urogenital triangle and the anal triangle.

17. identify the blood vessels and nerves supplying the structures of the

perineum.

18. pudendal block, epidural anaesthesia

19. identify other regions into which the superficial fascial layers of the

perineum are continuous.

20. identify the major arteries supplying the perineum.

21. describe the lymphatic drainage as it relates to the structures in this

region.

22. visualize and relate structures of the male and female perineum with

respect to adjacent structures

Applied anatomy of the pelvis and perineum

2h

1h

6h

1h

1h

2h

Anatomy to

arrange

Head/ Anatomy

Head/ Anatomy

Body-side

Tutorial

Lecture

Prosections

/Dissections

Lecture

Question

Discussion

Mock spot

2011-1/SBM-5/29

Development of the

male and female

reproductive

system

development of the reproductive system including development

abnormalities

4h Head/ Anatomy Lectures

2011-1/SBM-5/30

Menarche and

associated

problems

identify common problems associated with menarche

1h

Head/ Gyn. &

Obs.

Lecture

2011-1/SBM-5/31

Menopause and

Andropause

explain functional, structural and behavioural changes that occur during

menopause and andropause

1h Head/ Gyn. &

Obs.

Lecture


12

2011-1/SBM-5/32

Pregnancy

1. to appreciate the physiological and physical changes in pregnancy 1h

1h

Head/ Psychiatry

Head/ Gyn. &

Obs

Lecture

Lecture

2. describe the hormonal and physiological changes in mother during

pregnancy

3. describe the functional anatomy of the placenta

4. describe the processes of diffusion of the following across the

placenta O2, CO2, glucose and other nutrients

5. state the excretory functions of the placenta

3h

Head/

Physiology

Lecture

2011-1/SBM-5/33

Parturition,

pueperium and

lactation

1. describe the patterns of uterine contractions during pregnancy and

labour

2. explain the physiological events taking place during parturition

1. list the hormones involved in lactation and describe their role

2. describe the process of milk ejection and the role of oxytocin in milk

ejection

3. describe the patterns of prolactin secretion, its control by the

hypothalamus and state its actions

4. appreciate the psychological effects of parturition, pueperium and

lactation

5. appreciate the physiological and physical effects of parturition,

pueperium, lactation and the post partum regaining of body structure

1h

1h

1h

1h

Head/

Physiology

Head/

Physiology

Head/ Psychiatry

Head/ Gyn. &

Obs.

Lecture

Lecture

Lecture

Lecture

2011-1/SBM-5/34

Physiology of the

fetus

1. describe the functional development of circulatory system and

respiratory system of the fetus

2. describe the fetal adaptations for gas exchange

3. explain the readjustments at birth and changes in the neonatal period

of the blood, circulation, respiration, kidneys, liver, digestive system,

body temperature, metabolism and nervous system.

2h Head/

Physiology

Lecture

2011-1/CLM-5/02

laboratory investigation of a subfertile couple 1h

Head/ NMU Lecture (1h)


excretion & reproduction module (2011/12 batch) - year 1

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